SI Dysfunction ADD/ADHD Medication Issues

[lawd]

Our son has SI Dysfunction (first discovered via therapy for an Auditory Processing Disorder) and perhaps ADD/ADHD.  On Adderall (adderrall) XR 25 mg., the impulsivity is controlled but with side effects (sometimes signficant) such as emotional lability, nervousness, weight loss, sleeplessness, etc.  At the beginning of this school year, his new Dr. started him on Strattera 18 mg. with Adderall (adderrall) XR 20 mg.  The emotional side effects and nervous mannerism went away (perhaps because the Adderal dose is lower)but after a couple of weeks of observation, I would say that the Strattera seems to drive the impulsivity and sensory integration mannerisms we see (having to touch everything, etc.)  His teachers note that he is blurting out in class, not following directions, focusing on his own projects rather than paying attention in class, etc.  He does blurt out on the 25 mg. Adderall (adderrall), but it was in much better control last year on just the 25 mg. Adderall (adderrall) XR.  We tried just Strattera when it first came out.  The first week was great and then it made everything much worse in terms of his behavior.  The teacher reported it seemed like he was driven to extreme behaviors, even though he knew better and was immediately remorseful after doing them.  I am wondering if Strattera can intensify impulsivity and other ADD/ADHD  behaviors in kids with SI Dysfunction?  We need to find a better option to the Strattera alone or in combination with another drug, hopefully without the side effects we see with the Adderall (adderrall) XR 25 mg.

[Kevin Kennedy, Ph.D.]

In the Child and Adolescent Clinical Trials conducted as part of the process of developing Strattera and obtaining FDA approval, increase in impulsivity was not found to be a bothersome side effect. Rather small doses of stimulant medication have been found to be useful in conjuction with Strattera. A possible route to go would be to increase the Strattera dose and decrease the Adderall (adderrall) XR dose. It often makes sense to exhaust the various options with medications a child is currently on vs changing the medications. While it is not highly probable that  a switch to another stimulant would make a great deal of difference, it would be perfectly reasonable to see how your son does on a methylphenidate product such as Ritalin LA or Concerta. I do not know of any studies which document the impact of SI problems in conjunction with pharmacotherapy of ADHD.

[Marysmuse]

How absolutely interesting that this thread posted today.  I just googled Sensory Intergration Disorder and this forum popped up.

Is anyone who has a child with this problem aware of a resource for clothing made without seams or rough stitching?  A friend of my daughter's suffers from SID, and she has an awful time dressing in the mornings because she can't stand tags, seams, etc in her clothes.  It's becoming an issue at school- she has only a few outfits she'll wear, and kids are starting to notice that her clothes don't match or that she 'dresses weird'.

Thanks so much!
-Mary

[CLA, OTR/L]

As an occupational therapist working for nearly 20 years with children and adults with Sensory Integration issues (which are frequently stand-alone, but more often than not are comorbid with ADHD, learning disabilities and the autism spectrum disorders), I can share that there has been much research in the Occupational Therapy labs and clinics over the past 50 years using a multitude of approaches with what is now being called Sensory Processing Disorder (in the hopes that it will be included in the DSM-V when it is published).
  A recent study (not yet published) by Dr. Moya Kinnealy at Temple University, found in 150 experimental subjects of a 300-subject study that after sensory integration treatment, the 150 subjects were found to have little or none of their initial ADHD diagnostic features while those in the control group still demonstrated them. The point being that although the American Academy of Pediatrics does indeed recommend a pharmocological approach to the treatment of ADHD, the frequently-accompanying neurobehavioral and neuromotor issues are not remediated with medication alone, if at all. The AAP recommends other approaches besides medication as necessary and all too often, those other approaches are not recommended to families. Are we doing our families a disservice? I think so! With each script for Adderall (adderrall) or Strattera, we should also be writing another one for "Occupational Therapy evaluation and treatment as indicated". Better yet, try the OT first and then add the medication later.
  As for clothing without seams, your neighborhood OT can help you find those resources. One of them is www.sensorycomfort.com.
  Thank you for reading.
Christine Achenbach, MEd, OTR/L, BCP (Board Certified in Pediatrics by the American Occupational Therapy Association)
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[D99G03]

I just wanted to say that my son, now 6.5 was diagnosed with severe ADHD at around 4 yrs., which is very early.  He was involved with Early Intervention briefly and then at 3 yrs. placed in a special needs preschool due to not speaking and several other severe "global" delays, inclusing senory integration issues.  The ADHD symptoms have always been there, but as he grew, he did not "grow out" of the behaviors they got much much worse.  He is doing fairly well in most areas and has "caught up" nicely after years of intense therapies both at home and school.

Anyway, I just wanted to mention that so far we have had the best luck with Ritalin LA.  We tried Adderall (adderrall) and had severe side effects including major panic and hallucinations (very scary) and then we were given Strattera, which I thought was our miracle drug until it just stopped working all together shortly after we started it.  There are other "crosses to bare" with the Ritalin LA, one being that although it's called LA (Long Acting) for us it does not last all that long.  My son has been taking 40mg in the morning (high end dose) and we had to start him on 20 mg in the afternoon to get through the school day this year.  (his IEP has been pretty stripped this year and he just started 1st grade in a "typical" classroom ... not happy ... story for another forum ...)  Bottom line ... keep at it and keep trying new interventions until you find what works for you.  Kids and cases are all so different.  Not sure where you are located, but we have been extremely happy with the staff at Mass General Hospital in Boston.  Best of luck.

[AnnaJ]

My son was diagnosed with ADHD and problems with sensory integration. He was on ritalin for five years which helped the ADHD but had side effects. The worst side effects were lack of appetite which caused him to very thin. He also had sensory integration therapy which I highly recommend.

We also gave neurofeedback a try which helps to regulate the brain waves. His handwriting improved right away and was able to focus better.  His school work became much easier for him and he has become an avid reader.  He gets along better with his peers is so much easier to get along with. He no longer needs to take any medication.

Just wanted to let you know there are other things to try.

[AMG]

Our son is 4 years old and was diagnosed with SID at age 28 months.  He has been in birth to 3 then early learning through the school district.  He gets speach and OT 4 days a week and it has made a huge difference in him.  He is also very tall and large for his age weighing in at just under 77 lbs and 48 in tall.  Everyone expects him to act older than he really is, they don't understand SID at all.  His peditrician wants him evaluated for ADHD with a possible medication start now after telling me for 2 years she was sure he didn't have it. The school has been pushing this for some time and we have been saying no you are wrong.  He is a very active child but will sit down and concentrate if what you are doing challenges him or he finds it of intrest.  I have watched him pretend to fix his bike for over an half hour.   I just don't know where to turn to get good informations so my husband and I can make the right decisions about this.  Can anyone point me in the right direction?  Thanks